March 3, 1919-Coast Guard officers and enlisted men.

Also March 3, 1919-Employed seamen on vessels of the Mississippi River Commission.

Do you want me to continue?

Mr. DOWNING. No; it will not be necessary.

Mr. CLARK. When you get further into this listing, you get some what away from purely seamen or Coast Guard.

Mr. DOWNING. Is eligibility limited to only those people who are involved with the sea?

Mr. CLARK. No, sir. As you progress through this listing, it begins to get into other categories-for example, the reserve officers of the Public Health Service.

The CHAIRMAN. Mr. Ables.

Mr. ABLES. In 1965 we listed the beneficiaries of the Public Health

Service program. On page 2 of that report you will find that certain foreign seamen are privileged, certain officers and crews of the Fish and Wildlife Service, members of the Merchant Marine Cadet Service, members of the Coast Guard and dependents, retired personnel, members of the crews of vessels of the U.S. Coast and Geodetic Survey and, incidentally, as a result of the reorganization this year creating NOAA there is the possibility that the ESSA corps is now enlarged and there will be more beneficiaries than under the Coast and Geodetic Survey.

There are two additional categories listed on page 2.

Mr. CLARK. There are those in the Public Health Service and also those who were with it, but are no longer with it, who feel that this matter of drug addiction is one of the areas in which the Public Health Service might do a tremendous job. There are many other needs which I am sure other witnesses will describe to you in this area.

But the way to save the hospitals, it seems to me, is to expand these categories to meet the needs of the Nation.

The CHAIRMAN. Thank you very much, Mr. Clark.

Do you have anything to add, Mr. Haddock?

Mr. HADDOCK. Mr. Chairman, we are quite concerned about the President's statement on the health crisis.

We have been concerned about this for a long time, and its effect on the Public Health Service.

We find with the advent of the Department of Health, Education, and Welfare that the Public Health Service has really been downgraded, and the Surgeon General, who is the head of the Public Health Service, has become in the hierarchy of HEW practically nothing.

Looking toward the needs of the Nation and the kind of a job that Public Health Service could accomplish as shown by its history, we put together a program that we though ought to be followed in public health.

I will save the time of the committee. I will file that, but I would suggest that when these representatives of the agency come up here, you could probably go through this and you will find that you have a lot of questions that would be helpful to you set forth in here.

(The following was supplied for inclusion in the record at this point :)

THE NATION'S HEALTH CRISIS

The many health problems which plague our citizenry require prompt and continuing attention. The U.S. Public Health Service is the only organization in our entire nation which has the capability of finding and developing the answers to these problems. Additionally, the Public Health Service still has the complete respect of all. This is true despite the lack of funds to maintain optimum patient care and essential health programs which has resulted from budgetary privation. The P.H.S. has been forced from the position of leadership in the field of health to a weak organization—struggling to carry out a portion of its legislative responsibility.

This Committee is unable to find any record of any government agency which has so thoroughly been wrecked by budget manipulation. This is true despite a clear policy, responsibility, strong Congressional support and repeated stated support by several Administrations headed by both Democratic and Republican Presidents.

NATIONAL HEALTH NEEDS

Our citizens' $41 billion yearly health budget is by far the world's largest. Yet it is doubtful that we are getting anything close to the medical care or education for which we are paying. For example, our research effort of the National Heart Institute has been well funded. Yet more than 500,000 of our citizens, of which 190,000 are under 65 years of age, die yearly of coronary disease. Routine physical examinations which use miles of electrocardiograph paper and untold hours of laboratory work on blood sugar, uric acid and cholesterol tests have failed to stop the toll from heart disease. If a complete medical and physical examination is to be meaningful, it should mean the same to every doctor and patient. The development of standards and education of the doctors and patients are clearly indicated. On the other side of the heart disease picture, the dissemination of information and lack of health education has seriously hampered a program to reduce heart disease appreciably.

There is a growing awareness that periodic medical checkups are not the solution to proper medical care. Hospitalization for the convenience of the doctors has developed into a questionable practice. The U.S. Public Health Service leadership and education capability is needed by the health industry and the citizenry. Some of this results from high costs and great differences which exist between the examinations from different doctors.

Basic research has demonstrated that lack of exercise, obesity, smoking, heredity, and chronic mental anguish are by far the important causes of coronary heart disease. We do not need regular checkups by doctors with all of their tests to tell us that we are overweight and need to lose weight, or that smoking damages the arteries, lungs and heart. Nor do we need yearly checkups by doctors to induce us to engage in a meaningful physical fitness program.

Malnutrition is a serious national problem. We have the highest per capita consumption of food of any nation in the world. Yet, malnutrition at present exists even in homes where there is a sufficiency of food. While this problem has plagued peoples throughout recorded history, we still do not know what the effects of malnutrition are on the mental health of its sufferers. Doctors are notoriously unequipped as nutritionists. The USPH Service is equipped to provide leadership and education in this important health field.

How many of our criminals are the result of improper health conditions. Are there medical, mental or educational treatments available to prevent the development of these criminals? Once developed are there cures or physical corrections available to return them to society. Again the USPHS is competent to give leadership in this area which costs the U.S. taxpayer about $20 billion annually.

Finally, the national assimilation of data on coronaries by the health industry and the public suffers from the lack of centralized reporting and retrieval in coronary as well as all other health problems. This has kept the industry from using the great capacity of the computer to assist in solving major problems in health, indicating with almost pinpoint accuracy what disease any patient has and suggesting the procedures for successful cure or control of the condition.

It is generally known in the medical profession that the U.S. Public Health Service has developed programs to do this and more. However, the general public is neither aware of this nor the fact that this and the overall health leadership which the citizenry requires has been stopped cold by budgetary sleight of hand.

Today there is an acute shortage of hospital and nursing home beds, doctors, nurses and technicians. The U.S. Public Health Service should be in the forefront of finding better procedures to lighten this load on available personnel. Certainly they need to see that sufficient training is underway to meet these shortages. The U.S. Public Health Service should be permitted to eliminate the bed shortages for Federal beneficiaries where the most striking shortages exist. Their research, development, assimilation and dissemination of data on medical care at every stage could reduce considerably hospital stays as well as outpatient care. Leadership in the health field requires imaginative use of every available tool. The Public Health Service is peculiarly situated and suited to this task.

We should not overlook the medicare program and the apparent attempt of some in the health field to milk it dry. Clearly, the expertise and the esteem in which the U.S. Public Health Service is held by the citizenry is needed to develop standards and procedures to guard against these raids on the Medicare fund.

Any progress in the health field, even with the Public Health Service going full speed, must rely on education to be successful. The Public Health Service is strategically located in the HEW. Here it can disseminate information through its own organization to the health industry and generally the citizenry. Through the education industry it can reach every family associated with our education system. And of course education within the health industry cries for leadership. Medical schools' curriculum and student selection is under wide critical attack. The specialization within the profession has created problems which are putting the entire medical and hospital systems under great pressure. Yet no leadership exists which can competently inquire and honorably lead the way to solutions of such problems. The role of the U.S. Public Health Service is clearly to regain the leadership which it so well demonstrated in the period when Franklin Roosevelt was President and in the setting up and staffing the Veterans Administration Hospitals after the war, and to continue to imaginatively explore new medical care frontiers.

Mr. HADDOCK. Basically, what we say is that the Public Health Service is the only organization in the United States that is peculiarly equipped to give leadership in the health field to hospitals, to doctors, and to other organizations that are interested in this field.

This is the kind of a program that should be embarked upon by the Public Health Service.

My first administrative contact with the Public Health Service began with the Roosevelt administration. His administration, like every succeeding administration, has been faced with the question of closing of Public Health Service. When this was suggested to him, he asked for some reports and as a result of those reports he concluded that the Public Health Service should not be closed, that the Public Health Service should carry out its rightful place of giving leadership in the health of the Nation, and he said, "I am going out and find the best man I can to put in charge of this and give him this job to do,” and there is where Dr. Parrin, you may recall, entered into the picture. It was that kind of mission that he started the Public Health Service on.

Of course, the war came along and they built up their services to take care of the war needs. Immediately after the war they upped the service to provide service for the veterans in the veterans hospitals and since then they have been on the downgrade by each administration through budgetary deprivation.

There is no question about it, the Bureau of the Budget and now the Office of Management and Budget are out to end the Public Health Service. There is no question about this.

The hearings in 1965 are replete with instances of where and how

they have tried to achieve this. This is nothing more than a continuation of that situation.

But every President who has had the facts really placed before him has rebuked the Bureau of the Budget in that respect, but those boys never give up. They keep coming back and coming back, and this is where we are today.

I think, Mr. Chairman, with the filing of this which I hope you will find helpful, I will conclude my remarks.

The CHAIRMAN. Are there any questions?

Thank you very much, Mr. Haddock.

As chairman of the committee, I have always been under the impression that to close these hospitals they needed the sanction of the Congress, but it seems that the only way we can stop them from closing the hospitals is to put some sort of stipulation in the appropriations that none of the money can be used for phasing out any of the hospitals. Maybe that would put a stop to it.

Mr. HADDOCK. Mr. Chairman, I don't recall the exact date, but it was during the Eisenhower administration this question was up, and of course he reversed the Bureau of the Budget there also, and the Secretary, I must say, put up a very strong fight for these hospitals.

At that time, it was suggested to us and Mr. Clark and we had drafted an amendment to the then HEW appropriations on public health which would do basically what you said.

Senator Magnuson brought this up in the Senate Appropriations Committee and the then chairman, the senior Senator, Senator Hayden was chairman, and he said:

Maggie, I don't think this is the right place for it. I want an amendment drafted for all appropriations which will take the Bureau of the Budget out of the decisionmaking on how to run the administrative branches of the agencies and I want that kind of an amendment drafted for all of our appropriations.

Well, his counsel later on advised him that such an amendment covering the entire phase of the appropriations would be unconstitutional, so that it never went forward, but there have been these kinds of amendments adopted to specific appropriation bills and certainly the Bureau of the Budget, now the Office of Management and Budget, really needs to be taken out of running administrative agencies, but all of the administrations come right back to this.

They appoint whom they consider competent people to run the agencies and then they don't permit them to do anything. They run it from the Bureau of the Budget or from the White House.

The CHAIRMAN. Thank you very much.

I also have a telegram here from the Maryland Hospital Association. Without objection, I will insert it in the record. (The telegram to be supplied follows:)

Congressman ED GARMATZ,
Washington, D.C.:

MARYLAND HOSPITAL ASSOCIATION,
Lutherville, Md., December 22, 1970.

Urge your most deliberate efforts to prevent closure of Baltimore U.S. Public Health Service Hospital. Local private hospitals unable to absorb latter's caseload or workforce appearance. If dollar savings through closure is grossly deceptive, Government's direct participation in delivery of health care services essential from standpoint of understanding and solving problems of this industry.

USH is one of 55 members of this association. Will urge you to keep institution alive. More information to follow.

RICHARDSON J. DAVIDSON,
Executive Vice President.

Mr. CLARK. May I request permission to enter into the record a telegram we are sending to the White House?

The reason we could not send it yesterday we could not get Western Union but we are sending a telegram to the White House which we

would like to have entered into the record.

The CHAIRMAN. Yes, sir.

(The telegram follows:)

The PRESIDENT,

The White House,

Washington, D.C.:

[TELEGRAM]

DECEMBER 22, 1970.

The U.S. Public Health Service should provide continuing leadership to the Nation in medical and hospital care. The move by the Office of Management and Budget to close all general PHS hospitals and transfer those left to other facilities represents a move toward inadequate medical and hospital care for qualified beneficiaries including merchant seamen. We urge that you reverse this budgetary move and instead make the Public Health Service the Nation's leader in the field of hospital and medical service.

STATEMENTS

JOSEPH CURRAN,
SPYROS S. SKOURAS,

Cochairman, Labor-Management Maritime Committee.

OF BERTRAM GOTTLIEB, DIRECTOR OF RESEARCH, AND ROBERT VAHEY, ECONOMIST, TRANSPORTATION INSTITUTE

Mr. GOTTLIEB. I am Bertram Gottlieb, director of research, for the Transportation Institute.

With the Chair's permission, I would like to have Mr. Robert Vahey, an economist on my staff, to be with me at this hearing.

I, too, Mr. Chairman, would like to begin by complimenting the chairman and this committee for this hearing today. I think it is important for us not to be confronted with the situation where all of us who have a concern for the welfare of the merchant seamen get our information from newspapers.

I would certainly like to agree with Congressman Murphy and yourself that the inability of HEW to appear today and to help us get facts rather than newspaper accounts of what the Public Health Service and HEW is contemplating is really a crime.

I want to thank you for allowing me to present the views today of the shipowners who the Transportation Institute represents. Also I am authorized to speak for the Seafarers International Union.

I think I do not have to explain to you our concern in this matter both as shipowners and as union representatives, we are concerned with the best possible care that can be provided for the American merchant seaman.

You already heard some of the explanation today of the special problems which a merchant seaman faces. If a factory worker is injured on the job or he is ill and he goes to a hospital and he is forced to wait an extra day and if it is not a critical medical situation, it may mean he loses an extra day's pay, period.